IHE/HL7 Anatomic Pathology C.Daniel (ADICAP, ASIP Santé) & F.Macary (ASIP Santé) January 17, 2012 San Antonio.

IHE/HL7 Anatomic PathologyC.Daniel (ADICAP, ASIP Santé) & F.Macary (ASIP Santé)

January 17, 2012San Antonio

Anatomic Pathology Technical FrameworkCurrent Technical Framework - Revision 2.0

July 23, 2010. Copyright © 2010: IHE International, Inc.Trial Implementation Vol. 1 (PAT TF-1): Integration ProfilesVol. 2 (PAT TF-2): TransactionsThese volumes provide specification of the following

profile:Anatomic Pathology Workflow (APW)

Supplements for Trial ImplementationTo be tested at subsequent IHE Connectathons.  Supplements extend the IHE Anatomic Pathology

Technical Framework, Rev. 2.0 for Trial Implementation. 

Anatomic Pathology Reporting to Public Health (ARPH)  - Published 2010-07-23

Anatomic Pathology Structured Reports (APSR) - Published 2011-03-31 APSR Value Sets Appendix - Published 2011-03-312

Anatomic Pathology Laboratory

Order mgmt.Image mgmt

Care Ward

Patient mgmt.

APW: AP workflowAPW: AP workflow

ATNA

CT

PAM

PDQ

IT Infrastructure profiles

IHE Anatomic Pathology Existing and planned profiles

XDS

XDS-I

Report mgmt.

XDM

APSR: AP Structured

Report

APSR: AP Structured

Report

Security

Healthcare community

ARPH: AP Report for Public HealthARPH: AP Report for Public Health

Automation

IAPW:Inter AP labsworkflow

Docs./Image sharing

APDA:AP devices automation

APOR: AP opinion request

ARW:AP reportingworkflow

Enhanced Imagingworkflow

2011-12 Activity : Selection ofChange proposals/Profiles/White papers

2010-11 Change proposals : not

achieved Integration : Anatomic

Pathology Structured Order (APW - PAT-1)

Content: Anatomic Pathology Structured Reports (for Biobanks ) (APSR)

Integration Profiles Content Profiles White papers in progress

Anatomic Pathology Reporting Workflow (APRWF)(G.Rodriguez – Satec)

Enhanced Imaging Workflow Integration Profile

2011-12 ? Change proposals

Content: Anatomic Pathology Structured Reports (APSR) : 10 new templates

Integration Profiles -> 2012-13 Anatomic Pathology Reporting

Workflow (APRWF)(G.Rodriguez – Satec)

White papers -> 2012-13 Device automation integration

profile (with LAB, ITI) Inter-departments workflow

(with LAB ITI) Telepathology (with ITI) Opinion request (content and

workflow) Relationships between

pathology/radiology/endoscopy Sharing templates/terminology

(with ITI)

4

Change proposalNew APSR templates

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[APSR] – Anatomic Pathology Structured Report

Joint IHE and HL7 anatomic pathology initiative Content profile providing templates for building

Anatomic Pathology Structured Reports in all fields of anatomic pathology (cancers, benign neoplasms as well as non-neoplastic conditions) CDA documents including Anatomic Pathology

observations bound to images or regions of interest

Shared or exchanged within a community of care providers using existing integration profiles defined by IHE Information Technology Infrastructure

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Background (templates 2010-11) From clinical document models…

Recent recommendations for required, preferred, and optional elements for any APR of surgical pathology, regardless of report types [Goldsmith 08]

National initiativesAnatomic Pathology SR (Netherlands, Germany, Australasia)Cancer APSR

US - CAP (College of American Pathologists) 67 cancer checklists and protocols (October 2009)

France - SFP (French society of pathology) – INCa (French National Cancer Institute) Minimum data sets for cancer APSR in 20 locations (85% of new

cancers in France) (required by accrediting bodies) Australasia

6 templates for cancer APSR UK Royal college

Goldsmith, J.D., et al., Reporting guidelines for clinical laboratory reports in surgical pathology. Arch Pathol Lab Med, 2008. 132(10): p. 1608-16.

[APSR] – Anatomic Pathology Structured Report

Clinical Use Case to implement this profileSharing/exchanging APSR for surgical pathology21 CDA templates (Document Content Modules)

Generic APSR template All organs & fields of anatomic pathology

(inflammatory, vascular, traumatic, metabolic diseases as well as cancer)

20 organ-specific APSR templates Cancer-specific organizers covering 85% of incident

cancers490 observations & procedure templates

21 procedure templates469 observation temples (including 73 TNM observation

templates)8

New APSR templates (2011-12)Thematic needs

Patient care coordinationSurgical pathology

New organ-specific templates (n=20 -> 80) All specimen types (biopsies, cytology, etc)

AutopsyPublic health (e.g screening)Research (e.g bio-banking)

AP observations for biomarkers

National needsFrance : 7 new templates

Corresponding to 10 CAP cancer checklists

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10 CAP cancer checklists

Neuroendocrine tumor of the stomachNeuroendocrine tumor of the colon and rectumNeuroendocrine tumor of the small intestine and

ampullaNeuroendocrine tumor of the appendixCarcinoma of the endocrine pancreasCarcinomas of the nasal cavity and paranasal

sinusesTumors of the brain/spinal cord“Lymphoma”

Hodgkin lymphomaNon-hodgkin lymphoma

“Sarcoma”Tumors of soft tissueRhabdomyosarcoma

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HL7 CDA implementation guideHow to update APSRAnatomic Pathology Structured Reports

(APSR) -Providing OID for new templates

APSR Value Sets AppendixProviding OID for new

observations/procedure templatesProviding PathLex codes for new

observations, procedures, and their value sets

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National extensionsDifferences at the level of the document templates

Examples US France

Neuroendocrine tumors

4 templatesNET of - the stomach- the colon and rectum- the small intestine and ampulla- the appendix

1 templateNeuroendocrine tumors of digestive tract

Carcinomas of the pharynx

1 templateCarcinomas of the pharynx

3 templatesCarcinomas of -the oropharynx- the nasopharynx (biopsy)- the nasopharynx (resection)

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National extensions Other differencesAt the level of the observation templates

Harmonisation is possibleAt the level of the value sets

Harmonisation is difficultManaging international/national/local value

sets

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APSR templatesMaintainance (new profiles & versions)Issue

Proposing new templatesNew US CAP Cancer checklistsOther needs (e.g France INCa-SFP Cancer checklists)

Taking into account versionsUS CAP Cancer checklist versions Other?

Organizational issues - International governance?Harmonization?

US CAP Cancer checklist/ RCPA (Australasia)/UK RCPTechnical

Automation of the processDeriving HL7 CDA implementation guides from eCC

Intellectual properties rights?

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Significant deployment activitiesTimeline

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Significant Deployment Activity

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APW : implemented by vendors in "real world" in Spain (Hospital General de Ciudad Real) and on-going implementation in Paris (AP-HP) (ADICAP, ASIP Santé)

ARPH: North America (NAACCR, CDC) Successfully tested at 2010 (One sender, one

receiver) & 2011 (one sender, same receiver as 2010) NA Connectathon

APSR : on-going implementation by vendors in "real world" in France (ADICAP, ASIP Santé – INCa). National pEHR project (DMP & DCC project)

Timeline/Milestones

Date Activity Location2011

Sept 13-15, 2011

Submission of of 2011-12 Profiles/White papers

 IHE AP & HL7 AP - HL7 WGW - San Diego

Dec 2011 Selection of 2011-12 Profiles/White papers

2012Jan 2012 US Connectathon

Jan 16-18, 2012 IHE AP & HL7 AP - HL7 WGW - San Antonio

April 2012 European ConnectathonMay 13-18, 2012(to be confirmed)

PC&TC meeting IHE AP & HL7 AP - HL7 WGW – Vancouver

June 8, 2012(to be confirmed)

Publication of public comment supplement

11th Telepathology & 5th Virtual microscopy – Venice

August, 2012 Publication of trial implementation supplement

Ihe.net

Sept, 2012 Submission of of 2011-12 Profiles/White papers

IHE wiki

Sept, 2012(to be confirmed)

Selection of 2011-12 Profiles/White papers

IHE AP & HL7 AP - HL7 WGW – Cambridge17

11th ECT/5th ICVMVenice - Friday June 8, 2012?

18

Contact : [email protected]

HL7 Working Group MeetingVancouver, BC, May 13-18, 2012

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Learn More about IHE Anatomic PathologyGooglegroup : ihe-anatomic-pathology-

[email protected] Wiki

http://wiki.ihe.net/index.php?title=Anatomic_Pathology